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Paedatrics Flashcards

1
Q

What is impetigo?

What is a major RF for it?

A

Impetigo is a skin infection that is caused by a staph or a strep infection. It is very common in young children, highly infectious.

Major RF is pre existing skin disease already like eczema

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2
Q

What are the two types of impetigo?

A

Non Bullous (the more common form. You get the typical honey coloured rash etc)

Bullous: looks thinner more ulcerative. tends to be in the perianal, torso and limbs

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3
Q

What is the classical clinical presentation of impetigo?

A

You get runny nose, a bit itchy. crusty honey coloured lesions. Generally more obvious on the face. Auto inoculation to other areas.

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4
Q

How do you treat/manage impetigo?

A

You give antibacterial cream.
Get rid of nasal carriage by nasal cream
V infective so don’t go to school.

Moderate/severe: may need systemic or IV abx

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5
Q

What is Measles?

Is it a notifiable disease?

A

Is a RNA virus

Yes it is a notifiable disease

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6
Q

How can you remember the presentation of Measles?

A 
The 4 Cs 
Cranky 
Coryza 
Conjunctivitis 
Cough

You also have a rash that spreads from the ears through the rest of the body.
And Koplik spots on buccal membrane
Fever

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7
Q

What are 3 complications of measles?

A

pneumonia
encephalitis
deafness

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8
Q

What is the scientific name for croup?

A

laryngotracheobronchitis

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9
Q

How does croup present?

A

It presents mostly in young children 6 months to 6 years.

Generally fever and coryza beforehand.

Barking cough, hoarseness. That is worse at night.

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10
Q

What is the organism that causes croup?

A

Parainfluenza virus

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11
Q

How do you treat croup?

A

You treat it with dexamethasone
Steroid Nebs

If v bad give Nebs Adrenaline and Oxygen.

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12
Q

If you suspect croup but they have lots of airway secretion? What is the most likely diagnosis and how do you treat this?

A

Pseudomembranous Croup

Management IV abx and intubation

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13
Q

What are the two phases of whooping cough called? And what symptoms are shown in each phase?

A
  1. Catarrhal phase: 1 week of coryza symptoms
  2. Paroxysmal phase: coughing phase followed by the characteristic whoop. Here the child can go red/blue in the face and mucous can flow out of their nose/mouth.

Presentation can be via apnoea or sub conjunctival haemorrhage as well.

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14
Q

How would you diagnose whooping cough?

A

You would do a perinasal swab and see marked lymphocytosis on a FBC

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15
Q

How would you treat whooping cough?

Do you need to contact trace?

A

Erythromycin

Yes. Give erythromycin to all contacts

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16
Q

What are two likely causative organisms in peri-orbital cellulitis?

A

S Pneumoniae

H Influenzas

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17
Q

What additional tests do you need to do in orbital cellulitis?

A

CT scan to exclude infection

LP to exclude meningitis

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18
Q

What is the causative organism of epiglottis ?

A

H influenza

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19
Q

What age is epiglottis common in?

A

It is common in children aged 1-6 yrs

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20
Q

What symptoms are common in epiglottis?

A
  • High Fever, ill looking
  • Painful throat. Sat forward. Inspiratory stridor.
  • Saliva running down face.
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21
Q

How do you manage someone with epiglottis?

A

Need to secure the airway

Abx cefuroxime

Need to give prophylaxis to the entire household.

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22
Q

What is the treatment of candida/nappy rash in children?

A

You can give barrier cream/ointment (as prevention)

Steroid Cream +/- Anti fungal cream

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23
Q

What foods can cause a listeria infection?

A

Sprouts
Deli meats
Unpasteruised milk
Soft cheese

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24
Q

What are some of the symptoms/complications of having a listeria infection?

A

Symptoms: spontaneous abortion, meconium staining of liquor, neonatal sepsis, preterm delivery.

Then complications include sepsis, meningitis and pneumonia

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25
What antibiotic do you give in listeria infection?
Penicillin
26
is listeria gram +ve or -ve ?
Gram positive
27
What is treatment pathway for symptomatic TB?
Rifampicin Isoniazid Pyrazinamide Ethambutol All 4 for 4 months Then R + I for the remaining 2 months.
28
If asymptomatic for TB what is the treatment?
Rifampicin and Isoniazid | for 3 months
29
What type of pathogen is Rubella? Is it notifiable?
It is a RNA Virus It is a notifiable disease
30
How does rubella present?
You get a macular rash and sub occipital lymphadenopathy.
31
What are the complications of Rubella in utero?
Exposed in the first 4 weeks you get eye malformations weeks 4-8 you get cardiac deformity 8-12 weeks= deafness
32
What is the most common cause of Otitis Media?
The most common cause is viral i.e. RSV or rhinovirus Bacterial causes include S pneumoniae and H influenzae
33
What are 3 complications of otitis media?
- Mastoiditis - Meningitis - Glue Ear
34
What is Perthe's Disease?
This is when you get avascular necrosis of the femoral head
35
What are some RF for Perthe's Disease?
More common in Males Age 1-8 Mostly caucasian
36
How does Perthe's disease present?
Pain in the hip or knee Antalgic Gait 10-15% is likely to bilateral
37
What investigations are necessary for Perthe's Disease?
You need to do FBC, ESR/CRP X Rays MRI arthrogram
38
What is the management of Perthe's Disease?
You can do physio Not any good? Do surgery
39
What factors are low in Von willebrand's Disease?
you have low levels of factor 7 and vWF
40
What does the clotting screen of someone with VWD look like?
normal or APTT may be slightly increased
41
What is the diagnostic method of choice for Cystic Fibrosis in young children?
Sweat Test or via newborn heel prick test with immuno-reactive trypsinogen (IRT)
42
What is the diagnostic method of choice for CF in older children/adults?
Genetic Testing
43
What is the treatment for someone with CF?
So there is no treatment for someone with CF. You just need to manage the symptoms: Pancreatic insufficiency: give Creon and supplements/high calorie diet. Prophylactic abx, anti fungals etc Patient needs 2x daily physio and regular FEV measured
44
What is seen on the blood work of someone with Haemophilia A?
You will see Low Factor 8 and prolonged APTT
45
How do you treat haemophilia A?
You give them prophylactic infusions of factor 8 If an acute bleed occurs give Factor 8, desmopressin and anti-fibrinolytic
46
How do you treat haemophilia B acutely?
Factor 9 infusion Anti-fibrinolytic Desmopressin
47
What are 3 common organisms that cause encephalitis?
HSV EBV CMV VZV
48
What are two bacterial causes of encephalitis?
TB Malaria Secondary to meningitis
49
What is the triad presentation for encephalitis?
Altered mental state Headache Fever can also have focal neurological deficits
50
What are two infections you want to do for encephalitis? | What will they show?
LP which will show high lymphocytes. Send for PCR + culture and sensitivity MRI head
51
what is the management of encephalitis?
Acyclovir Anti seizure medication (primidone)
52
What is the stages for spot develop in chicken pox? (4 stages)
macule papule vesicle crust
53
What is the aetiology of retinoblastoma?
Inheritable via recessive inheritance Non inheritable via mutation
54
What is the presentation of retinoblastoma?
The presentation of retinoblastoma is generally leukocoria of one of the eyes. You can then get irritation of that eye (localised redness etc). Issues with seeing and a squint may develop. Can get CNS involvement and also if v progressed external swelling.
55
How do you diagnose a retinoblastoma?
Ophthalmoscope | MRI scan to look at the underlying structures
56
How do you treat the retinoblastoma?
Cryotherapy Photocoagulation Radiotherapy/ Chemotherapy If v advanced enucleation
57
How is prader willi syndrome inherited? What chromosome is affected?
Maternally Chromosome 15
58
What is the presentation of prader willi at birth?
Hypotonia Poor feeding Sleepiness Failure to thrive Generally blue eyes and blonde hair
59
What is the presentation of prader willi in toddlers?
Developmental Delay Growth restriction Behaviour and Learning difficulties Excessive appetite due to too much Ghrelin
60
How do you manage prader willi syndrome?
You manage PW syndrome by dietician review and controlling food consumption
61
What is Edwards Syndrome?
Trisomy of chromosome 18 | second most common trisomy behind Downs Syndrome
62
How does Edwards Syndrome present?
Wide spaced nipples Rocker bottom feet Clenched fists Microcephaly Heart congenital abnormalities i.e. ASD or VSD Deformed ears, cleft lip/palate or small mouth/jaw
63
What is Klinefelter's Disease? What conditions are at increased risk with this condition?
When a patient has XXY Breast Cancer Osteoporosis Diabetes Mellitus Autoimmune Conditions
64
How does Klinefelter's Disease present?
It presents through being very tall, wide hips, gynaecomatasia, sparse facial and pubic hair infertility and minor delay in learning/developmental issues
65
Is Wilm's Tumour an inherited condition?
Yes. | It is also a form of kidney cancer. If a child is high risk of developing a tumour. Do regular US scans.
66
What is nocturnal enuresis? When does it generally stop?
This is when you have bedwetting with no control at night. Due to a lax sphincter. SO is generally ok by age 7. 2/3rds of children have an affected parent.
67
How can you manage Nocturnal Enuresis?
You can have a star chart Enuresis alarm Short term desmopressin
68
Bone Tumours: What is an Ewings Sarcoma? What is an osteosarcoma?
Ewings is common in the shoulder blades and hips (generally weird places) Osteosarcoma is more common in older adolescent children. Happens in the long bones
69
How do bone tumours typically present?
They typically present with nocturnal pain. Localised bone swelling. Swelling over the area, difficulties walking. Systemic signs: weight loss, tiredness or night sweats
70
What organism is responsible for Hand Foot and Mouth Disease?
Coxsackie A virus
71
How does Hand foot and mouth disease present?
Painful itchy lesions on hand feet and mouth. Can be systemically unwell, malaise, loss of appetite, fever etc. Management: supportive off school until blisters heal
72
What condition does Parvo virus cause? What two groups do you have to be careful around?
Can cause slapped cheek syndrome Pregnant ladies and immunocompromised individuals as can cause an aplastic crisis. Note the patient will feel prodromally unwell as well.
73
If you looked under the microscope. What would the diphtheria organism look like?
gram positive aerobe.
74
What is the presentation of diphtheria?
You get a false grey membrane over the tonsils Purlent and bloody discharge from the nose Trouble with breathing, swallowing and talking Generally unwell: fever, malaise and anorexia
75
What is the management of diphtheria?
Erythromycin Also give it to close contacts
76
Are exomphalmos/gastroschisis generally diagnosed antenatally or postally?
Antenatally.
77
Describe what exomphalmos is? Who is it common in? How do you treat it?
Protrusion of the abdominal contents through the umbilical ring. Covered by a transparent sac. RF: include trisomy and other congenital abnormalities. Mx: surgery
78
Describe what gastroschisis is? Who is it common in? How do you treat it?
Is when you have the abdominal contents protruding adjacent to the umbilicus. No covering sac Common in those who use alcohol or ibuprofen in pregnancy. Treatment: cover in clingfilm and then do surgery
79
What are two likely organisms to cause septic arthritis?
S aureus | H Influenzas
80
How does septic arthritis present?
Erythematous, warm and tender joint Reduced ROM and movement from the affected joint. Febrile and a limp
81
How do you investigate and manage septic arthritis?
You investigate it with blood cultures, joint aspiration Note joint x ray will be normal up to 7 days post infection Management: need debridement, IV and and immobilisation.
82
What tumour marker will be raised in hepatoblastoma?
raised alpha feet protein
83
Where are brain tumours common in children?
Infra tectorial and posterior fossa
84
What is used to stage astrocytoma brain tumours?
WHO grading 1-4
85
What is the most common type of brain tumour?
Gliomas such as astrocytomas or olidgodendrogliomas.
86
What is Osgood Schlatter's Disease? What is the pathophysiology?
This is a condition involving the knee Common in adolescents. You get multiple small avulsion fractures where the quad muscle inserts. Common in growth spurts.
87
In Osgood Schlatter's Disease what makes the pain worse (2 things)?
Pain is worse with exercise Pain is worse on knee extension or against resistance
88
How do you manage Osgood Schlatter's Disease?
You manage it through rest, NSAIDs, physio
89
What is a neuroblastoma? What cell does it arise from?
Arises from the neural breast cells found in the adrenal medulla and sympathetic nervous system. Very common under the age of 5 and very malignant.
90
How does a neuroblastoma presents?
It presents with fatigue, anorexia and weight loss + vomiting Abdominal mass Periorbital bruising due to metastatic disease of the orbit. Gives raccoon eyes. Blueberry muffin appearance due to skin mets/ bone pain causing weakness, limping and paralysis
91
How do you diagnose neuroblastoma?
You diagnose it through CT and biopsy the lesion
92
How do you manage neuroblastoma?
Surgical resection Radiotherapy and Chemotherapy
93
What is the inheritance pattern of osteogenesis imperfecta? What does it affect?
It is an autosomal dominant inheritance condition. It affects type 1 collage: sclera, joints, bones, tendons and teeth
94
What are some of the symptoms of osteogenesis imperfecta?
You can get increased joint laxity increased bone fragility. Increasing bone fractures and thus pain and deformity. Impaired mobility Impaired growing Ligamentous Laxity.
95
What conditions is Osteogenesis Imperfecta associated with?
Valvular prolapse Hernias Deafness Blue appearance of the sclera
96
What is the criteria used to classify Osteogenesis imperfecta?
The Silence Criteria
97
What is the management of osteogenesis imperfecta?
The management is: Bisphosphonates Fracture splinting and also intramedullary rods may have to be placed in.

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